| NPI | 1558530170 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3319)  | 
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 1107)  | 
| Enumeration Date | 2008-02-28 | 
| Last Update Date | 2008-02-28 |